Veterans Affairs Launches New Claims And Appeals Modernization Process
The Department of Veterans Affairs just released its new procedures governing benefits claims and appeals as part of the 2017 appeals modernization laws.
This is the most dramatic change to VA benefits in decades that was created to address longstanding backlogs VA created due to the difficulty it had keeping up to its own workload. To fix it, VA pushed for and created its new appeals lanes that take an already complicated process and adds multiple layers of complexity on top of those procedures.
“This is a historic day for VA, its stakeholders and, most importantly, for Veterans and their families,” said VA Secretary Robert Wilkie. “The implementation of the Appeals Modernization Act comes as a direct result of collaboration among VA, Congress and Veteran Service Organizations to deliver on Veterans’ longstanding desire for reform of the legacy appeals system. Beginning today, Veterans will have greater choice in how VA reviews their disagreement with a VA claims decision and enjoy timely resolutions of disagreements through a streamlined process.”
VA says the goal of the new review options is to render decisions within 125 days. Appeals at the Board of Veterans Appeals intend to shorten the timeframe of appeals from seven years to one year.
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Veterans will now have the option of three decision review lanes: 1) Higher-Level Review, 2) Supplemental Claim, and 3) Appeal to the Board. At the Board, veterans will have another three adjudication options. Explained below:
- In the Higher-Level Review option, a more experienced adjudicator will conduct a new review of the previous decision.
- Veterans who select the Supplemental Claim option may submit new and relevant evidence, and VA will assist in developing new evidence under its duty to assist.
- If Veterans appeal a decision to the Board, they can choose one of three dockets: direct review, evidence or hearing.
VA apparently retains the duty to assist only on supplemental claims but not higher-level reviews or at the Board. Once the Notice of Disagreement is filed for a Board appeal, additional evidence can only be submitted for the first 90 days after the filing.
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The decision review centers are located in Washington DC, St. Petersburg, Florida, and Seattle, Washington. The agency received additional funding for FY 2019 to allow the hiring of an additional 605 appeals employees.
I started reading through the new instructions and some regulations. Internal procedures for VA Vocational Rehabilitation started to make my eyes bug out with all the new jargon and complexities.
The only history VA is making here is that which Jussie Smollet made after leaving the sub shop except this time the Veteran is going to get mugged by a scumbag Federal Employee working for Wlikie . Paid claims assassins. Watch your sixes brothers…
TODAY VA sent me a post regarding the MISSION ACT- open for public comments with a link to the site. I’ve tried the link and scanned for RIN 2900-AQ46. There is nothing there , they open comments pertiod is more Bullshit. How can you comment like this. Moe deliberate frustration for Veterans. I say Wilkie and his crew are the same Bums we have all seen before. Oh yeah , on the the issue of multiple lanes : they are just creating more jobs for insiders so they can ask for $, and burn up more taxpayer monies. SOS! Regarding who can you trust when it comes to organizing there is a bar to overcome — you have to be recognized by the Federal Government as such or as an NGO before you can preach to them. As for Congress, I think you have a better chance of getting sympathy from Princess Omar and Octasio Cortez but you know they won’t be around long because they’ve been branded as communists or radilcalized others from some place like Itzstinkzastan. One of those Stans.
Maybe Ben or anyone else will do some research into this. Maybe they can help someone with unpaid medical bills.
Off Topic: The newspaper has been running full page ads to pay off more than $5 million in medical bills owed by service members, veterans and their families. I don’t have much info but if you or any veteran you know has military medical debt look into this charity: McClatchy’s War Within Initiative along with RIP Medical Debt a nonprofit that buys and forgives medical debt across America. and their facebook page is listed at “https://www.facebook.com/WarWithinShow/”
Ben missed posting today? Is he O K?
Benjamin what did you find out about the new VR&E procedures?
I feel that VA new procedure will be problematic for the veterans who will take on this endeavor. in any new procedures their are going to be problems also VA have admitted that they have claim examiner that are at the low level for this procedure compare to experience claim examiner to automatic throw up a red flag.
Following
What can I say I am waiting for my appeal to be done at my Regional office on Wiltshire Blvd. With a judge. I can just think how this also while end up just like everything else has gone since I first filled my Claim. Just give use the run around which is hard to do when my records were lost in the fire of 1973. It sure makes you PROUD TO HAVE SERVED DOESN”T IT !!!.I WELL NOT GIVE UP THE FIGHT!!!!!!!
You may be surprised. I had a panel of 9 at a BVA hearing in 1990 in DC. They were ass holes. My BVA hearing in 2016 was very different. A very interested Judge who was great. As far as I can tell the only mistake that was made in the hearing was me not saying I was claiming CUE on my tinnitus. I’ve corrected that and expect to receive 30% not 10% because I was denied a Navy Fork Lift Operator’s Permit because of my tinnitus. Clear as ever in the EENT report. I filed a claim in 1974 for hearing difficulties. The reported hearing difficulties in my record is that EENT report. Though noise induced tinnitus didn’t make the rating chart until 1976, 38 CFR 4.20 calls for “Analogues ratings” for instances when a disabling condition exists but is not listed in the rating schedule. The rating is supposed to be assigned to the closest rating code to the actual condition which would have been the code for tinnitus from a TBI.
So the denial is at the CAVC and I’ve called it a CUE. Waiting for the Court’s Decision. They should remand under the applicable 38 CFR Regulations which will likely correct many tinnitus evaluations to 30% given the safety concerns that eliminate many “industrial employment opportunities.”
Ben,
Where did you locate the new VR&E procedures?
Unfortunately the VA rolls out the new Appeal Modernization Act and there is no VA Form 21-0958, Notice of Disagreement (NOD), available for the new Appeals process.
Just like the VA, they roll something out in a hap hazard way and the Veterans suffer for their incompetence.
Everything I would have said is pretty much stated in the comments. I will add though that we are not an organized community and I am working at changing that. Our politicians can ‘say’ they support us and then ignore our requests and calls when we try to call them on their ‘support’, the VA, well….we know what the VA is doing to us (they should at least have to buy us dinner first!), but most important (and this is after almost two decades of battling the VA) is that the VA is continuing to create a delayed-process that will allow them to continue to ask Congress for more and more money each year (despite doing so in the past and not delivering on the demands of the Committee) while continuing to delay and deny until we all die. The VA gave our medical information to Apple, then to the Swedish Company in Boston and now freely gives it all to the CDC, all without our permission. I say it is time to become organized and omit the VSOs (they only have their own best interests at heart anyways), the Politicians and the already-paid-for media outlets and take care of our community of veterans and bring the fight to their front door!
SKy, Who can we trust. All of the new organizations have just mimicked the old VSOs. A quad to quit of high salaried executives paying themselves with member dues and military industrial complex contributions (the bigger part). The military industrial complex wants those high paid execs to help limit the VA compensation entitlements.
If you are setting up an organization, make it online, no executive salaries period. No contributions from anyone without a DD 214 service qualifying as a veteran in a war period. And not something like DisabledVeterans.org that has to kneel to advertisers. Strictly a volunteer service site managed by volunteers so it is something veterans can trust no one is buying the organization executives off.
I don’t think there is a single VSO that doesn’t pay at least one of its top executives more than SECVA’s annual salary plus bonuses.
OMG – everyone’s comments today are spot on! Enough said – BAM
Peace Out
1) In the Higher-Level Review option, a more experienced adjudicator will conduct a new review of the previous decision.
No, they won’t. In every step of the “previous” process, this was supposed to happen, and never did. HLR was and will remain a rubber-stamp. Of the first decision.
2) Veterans who select the Supplemental Claim option may submit new and relevant evidence, and VA will assist in developing new evidence under its duty to assist.
No, they won’t. First and foremost, the VA employs “new” and “relevant” not as tools to assist Veterans explaining why they deserve service-connection, but as a means to exclude evidence and refuse to review claims. Secondly, the VA’s “duty to assist” has been held to be met by sending the Veteran a pile of VA forms requesting release of civilian medical records—not what the original intent of that law was, either.
If Veterans appeal a decision to the Board, they can choose one of three dockets: direct review, evidence or hearing.
Always, always, always choose to have a hearing, in-person if you can at manage it, by video conference if you can’t front the money for the travel (because why make it possible for Veterans to reach the place of hearing?). It takes forever. The VA will place every obstacle they can in your way, and you will still get rejected the first time through in almost all situations; BUT, a hearing puts you before an actual Administrative Law Judge—a far better level of training and support than the “one-and-out” rubber stamp of review.
Also, if you choose Hearing, the decision can be vacated (made null) if your Congressperson is not useless (or really good like mine was before Party R gerrymandered him East), and notices the VA didn’t actually read or answer your claim.
Some (scary) examples: It took me almost 7 years to win part of my claim (the PTSD part), after the very first reviewer made a factual mistake—the reviewer asserted that I did not have a diagnosis that I in fact, did (in my VA medical file, no less). All four reviewers—presumably more senior, simply passed my claim on “concur”. When my first appeal was rejected because “the VA making a factual mistake does not constitute ‘new or relevant’ information”, my Congressperson was instrumental in getting the Bush and Obama administrations to overturn this idiotic concept ( used on thousands of Veterans). The issue turned out to be that the VA Medical Branch used to use a term meaning “disprove this…”, which the VA taught claims processing personnel meant the Veteran did not have the condition—even if the result of the request to disprove was negative, meaning the Veteran did have the condition.
Until the VA is forced back into the service-provider role it was created for, and incentives are only given for patient care, the relationship between Veterans and the VA, and Congress and Veterans via the VA, will continue to be adversarial.
Both Party R and Party D see Veterans in the VA as costs to be reduced or eliminated. Both want the money from the VA for other programmes—Tax Cuts or Social Programmes, or whatever. They may laud us for our votes, but to paraphrase @Lem, they do not walk their walk about Disabled Veterans or especially retirees.
Rosie curious you had lot of typing as a Concerned Veteran you and i would have to say Benjamin Krause or very great Lawyers for Veterans.
Here’s the deal,
IF the VA had adjudicated the veterans claims correctly in the first place, the veterans claims wouldn’t have to be redone!
Makes sense, right!
Problem is, most VA employees are lazy, incompetent ASSHOLES, following someone’s ILLEGAL instructions! Then, there are some who, are afraid to speak up to those reprobates in the upper administration.
Amen! you hit the nail on the head.
Seems worse. The CAFC just made a decision on the DVA’s failure in the Duty to Assist. Now the DVA can shirk that obligation. New evidence within 90 days. In complicated cases like mine, I didn’t know the evidence existed and how it applied for more than 11 years. With anosognosia, I didn’t even know I had a problem and denied it to employers, co-workers, family and friends.
For TBI this is a shut down of compensation gains that have been made.
They are also going after PTSD compensation with this. A lot of victims tough it out until they can’t anymore. And that will be beyond those time limits. SOL has two meanings in this case, Statute of Limitations and shit out of luck.
Absolutely, though I would put it as “this is a shut-down of compensation gains that have been made”, full-stop.
The XX-day requirement has always been an administrative loophole employed by bureaucracies like VA and IRS to achieve non-compliance by the citizen. You have 30 days after the date at the top of this letter, which now gives you ten days after internal delays (like sending all mail from Austin, Tx, first by internal mail to Temple, Tx, and then mailing it, to “save money”) and the delay in the USPS.
Going after those SOLs. Currently in the CAVC and the 10th Circuit under Section 4 of the 14th Amendment and 7th Amendment. Common Law has a rule of “reciprocity”. Didn’t find any case citations but believe if it takes 8 years to process a claim by the DVA then a vet should have 8 years to make the claim or an appeal.
If it takes 32 years, as in the case of my TDIU, then I should have 32 years to gather the medical receipts to file claims to the VA Foreign Medical Office, etc.
And I’m going to argue that veterans with untreated TBI and PTSD have a hard time to just face filing a claim or dealing with any government agency. Thus the reason behind Section 4 of the 14th Amendment guaranteeing debts of the United States and with a specific line to veterans.
A few vitally important questions here.
Just how do we obtain hard copies of anything regarding VA/VHA/VBA that requires our signature BEFORE the signing? This begs another question; If the signature portion is required electronically, how do we know that the computer document is not, or never will be changed to suit whatever is in Uncle’s best interest?
As one common example: An in-office procedure would require the patient to sign an authorization, hold-harmless agreement, the rights of your first-born, what ever, we would never know for sure because there is this little “sign here” pad presented. And by the way, if you want to read it before you sign, it can be brought up on the practitioner’s computer, but the many pages of legalese are confusing at best, and with everyone waiting for the patient to get through the first paragraph,etc. and then it is downright nerve-wracking to get through to the end while looking for the gotcha’s.
This would seem to be standard procedure for everything related to servicemembers and veterans that would require their signature.
Since none of us really knows for sure, just what rights we have signed away or, if and when that actually would happen, are we in reality, just voicing opinions into thin air?
The point is, when we signed on at induction all servicemembers must have signed away all American born and God-given human rights, to became LIFE-long government chattel for Uncle to do with as desired, apparently up to and including murder.